Management of Contractural Deformities Involving the Shoulder (Axilla), Elbow, Hip, and Knee Joints in Burned Patients

Release of scar contracture across joints restores function and allows the burned patient to recover more completely. This chapter discusses the etiology and treatment of burn scar contractures restricting movement of major joints. The reader will find a concise discussion of the random fasciocutaneous local rotation/interposition flap. In the vast majority of functionally significant burn scar contractures, this operation affords the most efficient and effective means of providing living autologous tissue to the area of tissue deficit wherein arises the burn scar contracture. The interposition of an intact “integumentary functional unit” comprising epidermal, dermal, adipose, and fascial tissues with native nervous, vascular, and lymphatic connections allows this flap to release the intrinsic tissue tension driving scar hypertrophy and contraction. Accumulating cellular evidence indicates that this mechanically transduced signal may lead to myofibroblast apoptosis and more rapid resolution of scar hypertrophy.